Medication IG DE
1.0.0-ballot1 - 1.0.0

Medication IG DE, published by HL7 Deutschland. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7germany/medication-dosage-ig/ and changes regularly. See the Directory of published versions

Data Type Profile: DosageDgMP - Detailed Descriptions

Draft as of 2025-07-09

Definitions for the DosageDgMP data type profile.

Guidance on how to interpret the contents of this table can be foundhere

0. Dosage
Definition

Indicates how the medication is/was taken or should be taken by the patient.

ShortHow the medication is/was taken or should be taken
Control0..*
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
DosageStructuredOrFreeText: Dosage must be either structured or free text, but not both at the same time. ( (%resource.ofType(MedicationRequest).dosageInstruction | ofType(MedicationDispense).dosageInstruction | ofType(MedicationStatement).dosage).all( text.exists() and timing.empty() and doseAndRate.empty()) or (text.empty() and timing.exists() and doseAndRate.exists() ) )
2. Dosage.extension:generatedDosageInstructions
Slice NamegeneratedDosageInstructions
Definition

Diese Extension enthält die automatisch generierte textuelle Dosierungsanweisung, die auf Basis der bereitgestellten strukturierten Dosierungsinformationen erstellt wurde.

ShortMaschinell erzeugte Dosieranweisung
Control0..1
TypeExtension(Maschinell erzeugte Dosieranweisung) (Complex Extension)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
4. Dosage.extension:generatedDosageInstructions.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control20..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Dosage.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. Dosage.extension:generatedDosageInstructions.extension:text
    Slice Nametext
    Definition

    An Extension

    ShortExtensionAdditional content defined by implementations
    Control10..1*
    TypeExtension
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. Dosage.extension:generatedDosageInstructions.extension:text.extension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..0*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on Dosage.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 10. Dosage.extension:generatedDosageInstructions.extension:text.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuetext
      12. Dosage.extension:generatedDosageInstructions.extension:text.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control10..1
      Typestring, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Dosage.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
      • type @ $this
      • 14. Dosage.extension:generatedDosageInstructions.extension:text.value[x]:valueString
        Slice NamevalueString
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control10..1
        Typestring, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Dosage.extension:generatedDosageInstructions.extension:algorithm
        Slice Namealgorithm
        Definition

        An Extension

        ShortExtensionAdditional content defined by implementations
        Control10..1*
        TypeExtension
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. Dosage.extension:generatedDosageInstructions.extension:algorithm.extension
        Definition

        An Extension


        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortExtensionAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..0*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Dosage.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 20. Dosage.extension:generatedDosageInstructions.extension:algorithm.url
          Definition

          Source of the definition for the extension code - a logical name or a URL.

          Shortidentifies the meaning of the extension
          Comments

          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuealgorithm
          22. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]
          Definition

          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

          ShortValue of extension
          Control10..1
          TypeCoding, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Dosage.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 24. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding
            Slice NamevalueCoding
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control10..1
            BindingUnless not suitable, these codes SHALL be taken from For codes, see Algorithmen für Textgenerierung von Dosierungen
            (extensible to http://ig.fhir.de/igs/medication/ValueSet/DosageTextAlgorithms)
            TypeCoding, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Pattern Value{
              "system" : "http://ig.fhir.de/igs/medication/CodeSystem/DosageTextAlgorithms",
              "code" : "GermanDosageTextGenerator"
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.system
            Definition

            The identification of the code system that defines the meaning of the symbol in the code.

            ShortIdentity of the terminology system
            Comments

            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

            Control10..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to be unambiguous about the source of the definition of the symbol.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.version
            Definition

            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

            ShortVersion of the system - if relevant
            Comments

            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

            NoteThis is a business version Id, not a resource version Id (see discussion)
            Control10..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.code
            Definition

            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

            ShortSymbol in syntax defined by the system
            Control10..1
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to refer to a particular code in the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. Dosage.extension:generatedDosageInstructions.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Shortidentifies the meaning of the extension
            Comments

            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructions
            34. Dosage.extension:generatedDosageInstructions.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control0..01
            TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. Dosage.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            38. Dosage.sequence
            Definition

            Indicates the order in which the dosage instructions should be applied or interpreted.

            ShortThe order of the dosage instructions
            Control0..01
            Typeinteger
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. Dosage.text
            Definition

            Freitext-Dosierungsanweisungen, z. B. 'Maximal 3x täglich 1 Tablette bei Bedarf'. Als Quelle dient hier ausschließlich der Arzt oder Apotheker


            Free text dosage instructions e.g. SIG.

            ShortFreitext-Dosierungsanweisungen, z. B. 'Maximal 3x täglich 1 Tablette bei Bedarf'Free text dosage instructions e.g. SIG
            Comments

            Die Freitextdosierung sollte nur angegeben werden, wenn aufgrund der Komplexität keine strukturierte Dosierung möglich ist, um widersprüchliche Anweisungen zu vermeiden.

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. Dosage.additionalInstruction
            Definition

            Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

            ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
            Comments

            Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

            Control0..0*
            BindingFor example codes, see SNOMEDCTAdditionalDosageInstructionshttp://hl7.org/fhir/ValueSet/additional-instruction-codes
            (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

            A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. Dosage.patientInstruction
            Definition

            Anweisungen in einer für den Patienten oder Verbraucher verständlichen Sprache.


            Instructions in terms that are understood by the patient or consumer.

            ShortPatienten- oder verbraucherorientierte AnweisungenPatient or consumer oriented instructions
            Control0..01
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. Dosage.timing
            Definition

            Wann das Medikament verabreicht werden soll.


            When medication should be administered.

            ShortWann das Medikament verabreicht werden sollWhen medication should be administered
            Comments

            Um widersprüchliche Anweisungen zu vermeiden, ist entweder Dosage.timing oder Dosage.text zu befüllen. Falls eine strukturierte Dosierung als Text abgebildet werden soll ist dafür die GeneratedDosageInstructions Extension zu verwenden.


            This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

            Control0..1
            TypeTiming(Zeitmuster für Dosierungen im dgMP)
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. Dosage.asNeeded[x]
            Definition

            Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

            ShortTake "as needed" (for x)
            Comments

            Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

            Control0..01
            BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodeshttp://hl7.org/fhir/ValueSet/medication-as-needed-reason
            (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

            A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

            TypeChoice of: boolean, CodeableConcept
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. Dosage.site
            Definition

            Body site to administer to.

            ShortBody site to administer to
            Comments

            If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

            Control0..01
            BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodeshttp://hl7.org/fhir/ValueSet/approach-site-codes
            (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

            A coded concept describing the site location the medicine enters into or onto the body.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            A coded specification of the anatomic site where the medication first enters the body.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. Dosage.route
            Definition

            How drug should enter body.

            ShortHow drug should enter body
            Control0..01
            BindingFor example codes, see SNOMEDCTRouteCodeshttp://hl7.org/fhir/ValueSet/route-codes
            (example to http://hl7.org/fhir/ValueSet/route-codes)

            A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. Dosage.method
            Definition

            Technique for administering medication.

            ShortTechnique for administering medication
            Comments

            Terminologies used often pre-coordinate this term with the route and or form of administration.

            Control0..01
            BindingFor example codes, see SNOMEDCTAdministrationMethodCodeshttp://hl7.org/fhir/ValueSet/administration-method-codes
            (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

            A coded concept describing the technique by which the medicine is administered.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. Dosage.doseAndRate
            Definition

            Die verabreichte Menge des Medikaments.


            The amount of medication administered.

            ShortMenge des verabreichten MedikamentsAmount of medication administered
            Control0..1*
            TypeElement
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. Dosage.doseAndRate.type
            Definition

            The kind of dose or rate specified, for example, ordered or calculated.

            ShortThe kind of dose or rate specified
            Control0..01
            BindingFor example codes, see DoseAndRateTypehttp://hl7.org/fhir/ValueSet/dose-rate-type
            (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

            The kind of dose or rate specified.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            If the type is not populated, assume to be "ordered".

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. Dosage.doseAndRate.dose[x]
            Definition

            Amount of medication per dose.

            ShortAmount of medication per dose
            Comments

            Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

            Control0..1
            TypeQuantity(SimpleQuantity), Range
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Summarytrue
            Requirements

            The amount of therapeutic or other substance given at one administration event.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Dosage.doseAndRate.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
            • type @ $this
            • 62. Dosage.doseAndRate.dose[x]:doseQuantity
              Slice NamedoseQuantity
              Definition

              Menge des Medikaments pro Dosis.


              Amount of medication per dose.

              ShortMenge des Medikaments pro DosisAmount of medication per dose
              Comments

              Beachten Sie, dass dies die Menge des angegebenen Medikaments angibt, nicht die Menge für die einzelnen Wirkstoffe. Jede Wirkstoffmenge kann in der Medication-Ressource kommuniziert werden. Zum Beispiel, wenn man angeben möchte, dass eine Tablette 375 mg enthält und die Dosis eine Tablette beträgt, kann man die Medication-Ressource verwenden, um zu dokumentieren, dass die Tablette aus 375 mg des Wirkstoffs XYZ besteht. Alternativ, wenn die Dosis 375 mg beträgt, muss man möglicherweise nur angeben, dass es sich um eine Tablette handelt. Bei einer Infusion wie Dopamin, bei der 400 mg Dopamin in 500 ml einer Infusionslösung gemischt werden, würde dies alles in der Medication-Ressource kommuniziert werden. Wenn die Verabreichung nicht als sofortig vorgesehen ist (Rate ist vorhanden oder Timing hat eine Dauer), kann dies angegeben werden, um die Gesamtmenge anzugeben, die über den im Zeitplan angegebenen Zeitraum verabreicht werden soll, z. B. 500 ml in der Dosis, wobei Timing verwendet wird, um anzugeben, dass dies über 4 Stunden erfolgen soll.


              Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

              Control0..1
              BindingThe codes SHALL be taken from For codes, see KBV_VS_SFHIR_BMP_DOSIEREINHEIT
              (required to https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_BMP_DOSIEREINHEIT)
              TypeQuantity(SimpleQuantity), Range
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              The amount of therapeutic or other substance given at one administration event.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. Dosage.doseAndRate.rate[x]
              Definition

              Amount of medication per unit of time.

              ShortAmount of medication per unit of time
              Comments

              It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

              It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

              Control0..01
              TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
              Is Modifierfalse
              Summarytrue
              Requirements

              Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. Dosage.maxDosePerPeriod
              Definition

              Upper limit on medication per unit of time.

              ShortUpper limit on medication per unit of time
              Comments

              This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

              Control0..01
              TypeRatio
              Is Modifierfalse
              Summarytrue
              Requirements

              The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              68. Dosage.maxDosePerAdministration
              Definition

              Upper limit on medication per administration.

              ShortUpper limit on medication per administration
              Comments

              This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

              Control0..01
              TypeQuantity(SimpleQuantity)
              Is Modifierfalse
              Summarytrue
              Requirements

              The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              70. Dosage.maxDosePerLifetime
              Definition

              Upper limit on medication per lifetime of the patient.

              ShortUpper limit on medication per lifetime of the patient
              Control0..01
              TypeQuantity(SimpleQuantity)
              Is Modifierfalse
              Summarytrue
              Requirements

              The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

              Guidance on how to interpret the contents of this table can be foundhere

              0. Dosage
              InvariantsDosageStructuredOrFreeText: Dosage must be either structured or free text, but not both at the same time. ( (%resource.ofType(MedicationRequest).dosageInstruction | ofType(MedicationDispense).dosageInstruction | ofType(MedicationStatement).dosage).all( text.exists() and timing.empty() and doseAndRate.empty()) or (text.empty() and timing.exists() and doseAndRate.exists() ) )
              2. Dosage.extension:generatedDosageInstructions
              Slice NamegeneratedDosageInstructions
              4. Dosage.extension:generatedDosageInstructions.extension:algorithm
              Slice Namealgorithm
              6. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding
              Slice NamevalueCoding
              TypeCoding
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Pattern Value{
                "system" : "http://ig.fhir.de/igs/medication/CodeSystem/DosageTextAlgorithms",
                "code" : "GermanDosageTextGenerator"
              }
              8. Dosage.sequence
              Control0..0
              10. Dosage.additionalInstruction
              Control0..0
              12. Dosage.patientInstruction
              Control0..0
              14. Dosage.timing
              TypeTiming(Zeitmuster für Dosierungen im dgMP)
              16. Dosage.asNeeded[x]
              Control0..0
              18. Dosage.site
              Control0..0
              20. Dosage.route
              Control0..0
              22. Dosage.method
              Control0..0
              24. Dosage.doseAndRate
              Control0..1
              26. Dosage.doseAndRate.type
              Control0..0
              28. Dosage.doseAndRate.dose[x]
              TypeQuantity(SimpleQuantity), Range
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              30. Dosage.doseAndRate.dose[x]:doseQuantity
              Slice NamedoseQuantity
              BindingThe codes SHALL be taken from KBV_VS_SFHIR_BMP_DOSIEREINHEIT
              (required to https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_BMP_DOSIEREINHEIT)
              TypeQuantity(SimpleQuantity)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              32. Dosage.doseAndRate.rate[x]
              Control0..0
              34. Dosage.maxDosePerPeriod
              Control0..0
              36. Dosage.maxDosePerAdministration
              Control0..0
              38. Dosage.maxDosePerLifetime
              Control0..0

              Guidance on how to interpret the contents of this table can be foundhere

              0. Dosage
              Definition

              Indicates how the medication is/was taken or should be taken by the patient.

              ShortHow the medication is/was taken or should be taken
              Control0..*
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              DosageStructuredOrFreeText: Dosage must be either structured or free text, but not both at the same time. ( (%resource.ofType(MedicationRequest).dosageInstruction | ofType(MedicationDispense).dosageInstruction | ofType(MedicationStatement).dosage).all( text.exists() and timing.empty() and doseAndRate.empty()) or (text.empty() and timing.exists() and doseAndRate.exists() ) )
              2. Dosage.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              4. Dosage.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on Dosage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 6. Dosage.extension:generatedDosageInstructions
                Slice NamegeneratedDosageInstructions
                Definition

                Diese Extension enthält die automatisch generierte textuelle Dosierungsanweisung, die auf Basis der bereitgestellten strukturierten Dosierungsinformationen erstellt wurde.

                ShortMaschinell erzeugte Dosieranweisung
                Control0..1
                TypeExtension(Maschinell erzeugte Dosieranweisung) (Complex Extension)
                Is Modifierfalse
                Must Supporttrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                8. Dosage.extension:generatedDosageInstructions.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                10. Dosage.extension:generatedDosageInstructions.extension
                Definition

                An Extension

                ShortExtension
                Control2..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on Dosage.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 12. Dosage.extension:generatedDosageInstructions.extension:text
                  Slice Nametext
                  Definition

                  An Extension

                  ShortExtension
                  Control1..1
                  TypeExtension
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  14. Dosage.extension:generatedDosageInstructions.extension:text.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  16. Dosage.extension:generatedDosageInstructions.extension:text.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..0
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Dosage.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 18. Dosage.extension:generatedDosageInstructions.extension:text.url
                    Definition

                    Source of the definition for the extension code - a logical name or a URL.

                    Shortidentifies the meaning of the extension
                    Comments

                    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                    Control1..1
                    Typeuri
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    Fixed Valuetext
                    20. Dosage.extension:generatedDosageInstructions.extension:text.value[x]
                    Definition

                    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                    ShortValue of extension
                    Control1..1
                    Typestring
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Dosage.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 22. Dosage.extension:generatedDosageInstructions.extension:text.value[x]:valueString
                      Slice NamevalueString
                      Definition

                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                      ShortValue of extension
                      Control1..1
                      Typestring
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      24. Dosage.extension:generatedDosageInstructions.extension:algorithm
                      Slice Namealgorithm
                      Definition

                      An Extension

                      ShortExtension
                      Control1..1
                      TypeExtension
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      26. Dosage.extension:generatedDosageInstructions.extension:algorithm.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      28. Dosage.extension:generatedDosageInstructions.extension:algorithm.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control0..0
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on Dosage.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 30. Dosage.extension:generatedDosageInstructions.extension:algorithm.url
                        Definition

                        Source of the definition for the extension code - a logical name or a URL.

                        Shortidentifies the meaning of the extension
                        Comments

                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                        Control1..1
                        Typeuri
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        Fixed Valuealgorithm
                        32. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]
                        Definition

                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                        ShortValue of extension
                        Control1..1
                        TypeCoding
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on Dosage.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 34. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding
                          Slice NamevalueCoding
                          Definition

                          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                          ShortValue of extension
                          Control1..1
                          BindingUnless not suitable, these codes SHALL be taken from Algorithmen für Textgenerierung von Dosierungen
                          (extensible to http://ig.fhir.de/igs/medication/ValueSet/DosageTextAlgorithms)
                          TypeCoding
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Pattern Value{
                            "system" : "http://ig.fhir.de/igs/medication/CodeSystem/DosageTextAlgorithms",
                            "code" : "GermanDosageTextGenerator"
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          36. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.id
                          Definition

                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          38. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on Dosage.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 40. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.system
                            Definition

                            The identification of the code system that defines the meaning of the symbol in the code.

                            ShortIdentity of the terminology system
                            Comments

                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            Need to be unambiguous about the source of the definition of the symbol.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            42. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.version
                            Definition

                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                            ShortVersion of the system - if relevant
                            Comments

                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                            NoteThis is a business version Id, not a resource version Id (see discussion)
                            Control1..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            44. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.code
                            Definition

                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                            ShortSymbol in syntax defined by the system
                            Control1..1
                            Typecode
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            Need to refer to a particular code in the system.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            46. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.display
                            Definition

                            A representation of the meaning of the code in the system, following the rules of the system.

                            ShortRepresentation defined by the system
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            48. Dosage.extension:generatedDosageInstructions.extension:algorithm.value[x]:valueCoding.userSelected
                            Definition

                            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                            ShortIf this coding was chosen directly by the user
                            Comments

                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                            Control0..1
                            Typeboolean
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            50. Dosage.extension:generatedDosageInstructions.url
                            Definition

                            Source of the definition for the extension code - a logical name or a URL.

                            Shortidentifies the meaning of the extension
                            Comments

                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            Fixed Valuehttp://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructions
                            52. Dosage.extension:generatedDosageInstructions.value[x]
                            Definition

                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                            ShortValue of extension
                            Control0..0
                            TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            54. Dosage.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            56. Dosage.sequence
                            Definition

                            Indicates the order in which the dosage instructions should be applied or interpreted.

                            ShortThe order of the dosage instructions
                            Control0..0
                            Typeinteger
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            58. Dosage.text
                            Definition

                            Freitext-Dosierungsanweisungen, z. B. 'Maximal 3x täglich 1 Tablette bei Bedarf'. Als Quelle dient hier ausschließlich der Arzt oder Apotheker

                            ShortFreitext-Dosierungsanweisungen, z. B. 'Maximal 3x täglich 1 Tablette bei Bedarf'
                            Comments

                            Die Freitextdosierung sollte nur angegeben werden, wenn aufgrund der Komplexität keine strukturierte Dosierung möglich ist, um widersprüchliche Anweisungen zu vermeiden.

                            Control0..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            60. Dosage.additionalInstruction
                            Definition

                            Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

                            ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
                            Comments

                            Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

                            Control0..0
                            BindingFor example codes, see SNOMEDCTAdditionalDosageInstructions
                            (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

                            A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            62. Dosage.patientInstruction
                            Definition

                            Anweisungen in einer für den Patienten oder Verbraucher verständlichen Sprache.

                            ShortPatienten- oder verbraucherorientierte Anweisungen
                            Control0..0
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            64. Dosage.timing
                            Definition

                            Wann das Medikament verabreicht werden soll.

                            ShortWann das Medikament verabreicht werden soll
                            Comments

                            Um widersprüchliche Anweisungen zu vermeiden, ist entweder Dosage.timing oder Dosage.text zu befüllen. Falls eine strukturierte Dosierung als Text abgebildet werden soll ist dafür die GeneratedDosageInstructions Extension zu verwenden.

                            Control0..1
                            TypeTiming(Zeitmuster für Dosierungen im dgMP)
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            66. Dosage.asNeeded[x]
                            Definition

                            Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

                            ShortTake "as needed" (for x)
                            Comments

                            Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

                            Control0..0
                            BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
                            (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

                            A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

                            TypeChoice of: boolean, CodeableConcept
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            68. Dosage.site
                            Definition

                            Body site to administer to.

                            ShortBody site to administer to
                            Comments

                            If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

                            Control0..0
                            BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
                            (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

                            A coded concept describing the site location the medicine enters into or onto the body.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            A coded specification of the anatomic site where the medication first enters the body.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            70. Dosage.route
                            Definition

                            How drug should enter body.

                            ShortHow drug should enter body
                            Control0..0
                            BindingFor example codes, see SNOMEDCTRouteCodes
                            (example to http://hl7.org/fhir/ValueSet/route-codes)

                            A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            72. Dosage.method
                            Definition

                            Technique for administering medication.

                            ShortTechnique for administering medication
                            Comments

                            Terminologies used often pre-coordinate this term with the route and or form of administration.

                            Control0..0
                            BindingFor example codes, see SNOMEDCTAdministrationMethodCodes
                            (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

                            A coded concept describing the technique by which the medicine is administered.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            74. Dosage.doseAndRate
                            Definition

                            Die verabreichte Menge des Medikaments.

                            ShortMenge des verabreichten Medikaments
                            Control0..1
                            TypeElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            76. Dosage.doseAndRate.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            78. Dosage.doseAndRate.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on Dosage.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 80. Dosage.doseAndRate.type
                              Definition

                              The kind of dose or rate specified, for example, ordered or calculated.

                              ShortThe kind of dose or rate specified
                              Control0..0
                              BindingFor example codes, see DoseAndRateType
                              (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

                              The kind of dose or rate specified.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              If the type is not populated, assume to be "ordered".

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              82. Dosage.doseAndRate.dose[x]
                              Definition

                              Amount of medication per dose.

                              ShortAmount of medication per dose
                              Comments

                              Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

                              Control0..1
                              TypeQuantity(SimpleQuantity)
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              The amount of therapeutic or other substance given at one administration event.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on Dosage.doseAndRate.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                              • type @ $this
                              • 84. Dosage.doseAndRate.dose[x]:doseQuantity
                                Slice NamedoseQuantity
                                Definition

                                Menge des Medikaments pro Dosis.

                                ShortMenge des Medikaments pro Dosis
                                Comments

                                Beachten Sie, dass dies die Menge des angegebenen Medikaments angibt, nicht die Menge für die einzelnen Wirkstoffe. Jede Wirkstoffmenge kann in der Medication-Ressource kommuniziert werden. Zum Beispiel, wenn man angeben möchte, dass eine Tablette 375 mg enthält und die Dosis eine Tablette beträgt, kann man die Medication-Ressource verwenden, um zu dokumentieren, dass die Tablette aus 375 mg des Wirkstoffs XYZ besteht. Alternativ, wenn die Dosis 375 mg beträgt, muss man möglicherweise nur angeben, dass es sich um eine Tablette handelt. Bei einer Infusion wie Dopamin, bei der 400 mg Dopamin in 500 ml einer Infusionslösung gemischt werden, würde dies alles in der Medication-Ressource kommuniziert werden. Wenn die Verabreichung nicht als sofortig vorgesehen ist (Rate ist vorhanden oder Timing hat eine Dauer), kann dies angegeben werden, um die Gesamtmenge anzugeben, die über den im Zeitplan angegebenen Zeitraum verabreicht werden soll, z. B. 500 ml in der Dosis, wobei Timing verwendet wird, um anzugeben, dass dies über 4 Stunden erfolgen soll.

                                Control0..1
                                BindingThe codes SHALL be taken from KBV_VS_SFHIR_BMP_DOSIEREINHEIT
                                (required to https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_BMP_DOSIEREINHEIT)
                                TypeQuantity(SimpleQuantity)
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Must Supporttrue
                                Summarytrue
                                Requirements

                                The amount of therapeutic or other substance given at one administration event.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                86. Dosage.doseAndRate.rate[x]
                                Definition

                                Amount of medication per unit of time.

                                ShortAmount of medication per unit of time
                                Comments

                                It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

                                It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

                                Control0..0
                                TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                88. Dosage.maxDosePerPeriod
                                Definition

                                Upper limit on medication per unit of time.

                                ShortUpper limit on medication per unit of time
                                Comments

                                This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

                                Control0..0
                                TypeRatio
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                90. Dosage.maxDosePerAdministration
                                Definition

                                Upper limit on medication per administration.

                                ShortUpper limit on medication per administration
                                Comments

                                This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

                                Control0..0
                                TypeQuantity(SimpleQuantity)
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                92. Dosage.maxDosePerLifetime
                                Definition

                                Upper limit on medication per lifetime of the patient.

                                ShortUpper limit on medication per lifetime of the patient
                                Control0..0
                                TypeQuantity(SimpleQuantity)
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))